Topics Related to Medicaid Direct

NC Medicaid Direct Member Reassignment Process

Instructions for providers requesting removal of NC Medicaid Direct members from their patient panel

Update: Retroactive Disenrollment from NC Medicaid Managed Care

Providers should submit claims for dates of service that now fall in NC Medicaid Direct.

NC Medicaid to Remove Copays for HIV Antiretroviral Medications

Effective Nov. 1, 2023, NC Medicaid will remove all copay requirements for antiretroviral medications which decrease viral load in patients with HIV.

Hospital at Home Program Re-Launching for NC Medicaid

Hospital at Home Program Re-Launch: NC Medicaid will cover the Acute Hospital at Home Program starting Nov. 1, 2023. NOTE: This Bulletin was revised on April 2, 2024 to correct an error. In the original version, published Sept. 27, 2023, it was stated that the Hospital at Home Program had a previous end date of March 31, 2021. Prior to relaunch, the previous end date was March 31, 2022, as corrected and explained below.

REMINDER: Electronic Visit Verification (EVV) Home Health Implementation Hard Launch Effective Oct. 1, 2023

Claims without the required EVV data will be denied.

Updated: NC Medicaid Temporary Flexibilities Due to Hurricane Idalia

This bulletin replaces NC Medicaid Temporary Flexibilities Due to Hurricane Idalia published on Aug. 30, 2023, to correct the end date.

NC Medicaid Temporary Flexibilities Due to Hurricane Idalia

Provider guidance for reimbursement, enrollment and providing care for Medicaid beneficiaries

Specialty Care Referrals in NC Medicaid Reminder: NC Medicaid does not require referrals for specialty care.

This bulletin provides information about referrals for specialty care for NC Medicaid beneficiaries.

CMS Approves New Flexibilities for the NC Medicaid Reform Section 1115 Demonstration Project

Includes flexibilities related to Tailored Plans and Healthy Opportunities Pilots

NC Medicaid Planning for October 1 Medicaid Expansion Launch

With state budget negotiations ongoing, NCDHHS has worked with CMS to negotiate a compromise to begin submitting documents needed for federal approval to launch Medicaid expansion on October 1, 2023.